• Healthy eating had no effects on rates of cardiovascular disease.• Healthy eating had no effects on rates of breast or colorectal cancers.• Women who followed a "healthy (lower-fat) diet did not wind up thinner.• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.

Did you read any news stories about this? Me neither.

Results from Part II are about to come out. I can't wait to not read those, too.

20 comments:

In women, the risk of all-cause and coronary heart disease mortality continues to increase as body mass index (BMI) rises above 30, according to the latest findings from the Women's Health Initiative (WHI) Observational Study.

"It's not good enough to consider obesity alone," principal investigator Dr. Kathleen McTigue of the University of Pittsburgh, Pennsylvania, told Reuters Health. "You need to look at degree of obesity."

In a study published in the July 5th Journal of the American Medical Association, Dr. McTigue and colleagues studied patterns of morbidity and mortality risk according to BMI in 90,185 women in the WHI study who were not in the diet or hormone treatment arms of the study. Average follow-up was 7 years.

Body mass index (BMI) was classified using NIH definitions of normal, overweight and obesity. Normal weight BMI ranged from 18.5 to 24.9 and overweight was defined as a BMI of 25-29.9. The investigators defined three categories of obesity: obesity 1 (BMI of 30-34.9), obesity 2 (BMI 35-39.9) and extreme obesity (BMI 40 and higher).

"The risks of extreme obesity have not been well-defined," Dr. McTigue noted. "This was a large enough sample to assess risk."

The prevalence of extreme obesity varied by ethnicity, occurring in 10% of black women and 1% of Asian and Pacific Islanders. However, all-cause mortality, coronary heart disease mortality and coronary heart disease incidence did not vary by ethnicity.

"There is an increasing risk of all-cause mortality with increasing weight, but it doesn't reach statistical significance until obesity exists," Dr. McTigue told Reuters Health. Compared with normal-weight women, she continued, "the risk of dying was increased 12% in all women in obesity category 1, while risk was increased 86% over seven years in women in obesity category 3."

Summing up, she said, "The coronary heart disease and all-cause mortality risk increases along a continuum."

In a University of Pittsburgh release, the researcher pointed out that "earlier studies, which tended to reflect lower degrees of obesity, may underestimate the risks of extremely obese individuals and overestimate the risk for mildly obese individuals in diverse groups."

She concluded, "More accurately assessing weight-related health risk may both improve policy decisions about obesity and assist women in making informed decisions about their health."

I haven't read the entire study, but it sounds like it's describing the famous U-shaped mortality curve--mortality increases at either end of the curve, so with extreme obesity and with extreme slenderness. Those are the results Katherine Flegal found that were so controversial a few years back that people have been trying to cover them up or discount them ever since.

Besides, Szwarc was not writing about the relationship between weight and mortality. She was writing about the effectiveness of so-called "healthy eating" behaviors on incidence of disease. And the study did not find any.

The presence of the U-shaped curve is neither here nor there, especially since the women in the study who ate less fat and "healthier" *did not weigh any less* than those who didn't.

Susie, thanks for the link. The family meal seems to have an almost ridiculous amount of protective benefit for kids, whether they're eating takeout or home-cooked, in front of the TV or on white tablecloths. Seems like we're social animals who need to eat together.

McTigue was not among the researchers of the WHI study. It is an aftermarket spin of the results, but scaring people by micro-analyzing nonstatistically significant results does not make them more important or credible.

Maybe this explanation will help. What the first anonymous was confused about is that there were multple parts of the WHI studies. [See here: http://clinicaltrials.gov/show/NCT00000611 ]One part was a standard observational study looking for correlations among women who filled out questionnaires and visited a clinic once at year three. That had all of the same flaws as any other such data dredge. But there were actual clinical trials under WHI and those were the much stronger research that the medical community was eagerly awaiting. You’ve probably heard about the HRT clinical trial, for example. What was discussed in this article was the huge dietary interventional clinical trial looking specifically if a 'healthy' low-fat diet has any effect on cancers and heart disease or weight. All of the things the government advocates and we've all come to believe. And Harriett is right, the media only reported this study from carefully crafted press releases, not simply the facts.Sandy

The presence of the U-shaped curve is neither here nor there, especially since the women in the study who ate less fat and "healthier" *did not weigh any less* than those who didn't.

Thank you, Harriet. We get hyped so relentlessly, we fat folks, on how "wrong" we are eating and that if we only ate "right," like these postmenopausal women did in the study -- cutting calories by about 350 a day, eating lots of whole grains and fruits and veggies -- we'll get to join the privileged slim. But for most women this does not work. It does not work. It does not work.

Therefore, telling us that thin women live longer and are healthier than fat women is a little like telling poor women that if they just made five times as much money their financial problems would be solved. If there is no concrete way of turning most poor women affluent, that piece of information is completely irrelevant.

It's not irrelevant. If there was a proven way to lose weight and keep it off safely, this says that you might be able to save lives.

Maybe 350 calories isn't enough.

Calorie restriction is proven in many studies to extend the lives and youth of rodents by quite a lot.

It is a lifestyle change, not a temporary diet. I eat about 1200 calories of healthy, balanced food a day, and I'm not hungry for more. My blood pressure, pulse rate blood sugar, body fat, and arthritis got awesomely better after a couple years. It's pretty impossible to be overweight doing this long-term. I'm not denying myself any deserts, I'm just eating small portions, like what people do in Japan or France anyway.

If YOU can eat 1200 calories a day, be healthy, and honestly not be hungry except at mealtime, then that is probably about what your body needs.

My body, for one, needs a lot more. On 1500-1800, I am dizzy, faint, irritible, bloated and utterly obsessed with food. A few weeks ago, I stopped thinking about calories, started eating more. Did I suddenly gain a pound for every extra 3500 calories? No, I gained a pound or two of pretty much solid muscle. (my waist measurement is the same, my clothes feel even looser and my legs have started getting more defined. Yay muscle!)

Clearly, 1200 calories is not appropriate for me. Maybe it might result in weight loss, but I'll take the sanity, strength and health over that. And fwiw, I'm a 5'2" female with a "societally accepted as healthy" weight. But I could just as easily be taller or shorter or heavier or lighter and STILL have different needs than you.

This is totally anecdotal, but so is yours. The point is everyone is different and health looks different for everyone. I'm not saying this as a "look at me!" I'm saying it to make a point that things aren't that simple. I had to make a conscious effort to realize that the portion size someone like you eats are unhealthy and inappropriate for me, unless I am eating every hour.

If what you're doing works for you, great. But don't assume it works for everyone. And I won't assume that everyone else needs to lay off the salad and eat bigger portions.

And as for the oft-cited rodent study. The reason the rodents lived longer was because their reproductive systems shut off at lower caloric intakes. Having lots of rat babies = a lot of wear and tear = longer life.

It's not irrelevant. If there was a proven way to lose weight and keep it off safely, this says that you might be able to save lives.

I call BS. There is NO -- none, zero, pingpong ball, doughnut, N-O -- proof that fat people who lose weight lengthen their lives (for more than perhaps a few weeks) because of it. I defy you to find a single study that bears that out. Part of the reason you can't find one, of course, is that almost nobody CAN pull this off. But even when it's been studied, nobody has been able to find any relationship between lengthened life and artificially lowered BMI. And it's not like they haven't looked under every rock, either.

I eat about 1200 calories of healthy, balanced food a day, and I'm not hungry for more. My blood pressure, pulse rate blood sugar, body fat, and arthritis got awesomely better after a couple years. It's pretty impossible to be overweight doing this long-term. I'm not denying myself any deserts, I'm just eating small portions, like what people do in Japan or France anyway.

Well, if you are never hungry on 1200 calories a day, day in and day out, bully for you. I guarantee you that most human adults (yes, including the French and Japanese) would be, at least if they're not smoking four packs a day or on chemical appetite suppressants or otherwise too sick to eat.

And frankly, telling the author of a blog whose daughter very nearly died from anorexia that no woman should ever need more than 1200 calories a day is jawdroppingly thoughtless behavior. No, I'm sorry, nobody should be FORCED to eat that little every single day forever, or should have it implanted in their head that they are abnormally greedy if they do. If you want to practice CRE yourself, have at it, but leave the moralizing out of it, please.

And if you think nobody could possibly eat that little and sustain an "obese" body, you are dead wrong about that too. See The Rotund's blog (sample post link here) for a vivid illustration of that.

Meowser, couldn't have said it better. I was sitting here trying to compose a response that went something like "If you've never watched someone starve themselves to death on 1200 and 1000 and 800 and 400 calories a day, well, you're lucky."

If we're talking CR, then I've got to say I think you guys are all anorexics in disguise. So long as you're consenting adults, have at it. (Or don't have it.) But don't hold yourselves up as healthy models for the rest of the human race, because you're not.

I'd rather die early than live on 1200 calories a day. Too little food makes me cranky, irritable, unable to concentrate, and a general wreck. My weight has been stable for 10 years, I exercise vigorously and often, and I look pretty good, even though I wear a size 14 or 16. I'm at a good weight for me. More importantly, I no longer obsess about food. I no longer look forward to each meal with the saliva-filled devotion of a German shepherd. I don't worry about getting enough to eat. I don't overeat, as a rule. I eat plenty of "healthy" foods like fruits and veggies, and I eat dessert when I damn well want to and don't worry about it the rest of the time.

I've never had a better relationship with food, with my body, and with the rest of the world. That's what 2500 calories a day will do for a woman.

Well said Meowser, HB and others! I just wanted to add that my attempts at calorie restriction aided and abetted 25 + plus solid clinical depression. Only ceasing all attempts at not simply 'calorie control' (which of course isn't control, it's rule by calorie), but pseudo moralising -good/bad food, talking up food as super tasty or down as junk and if I find any more remnants of the 'obesity crisis' that will be tossed too. To me food is like breathing, I just do it, that is it, only then is the threat removed the nervous system has a chance to calm down I could then get on with my other problems, rather than creating unnecessary ones, I sincerely hope this will be a little use to others. Each of us are precious and UNIQUE.

France actually has an "obese" and "overweight" population approaching that of the English-speaking countries. I have it on good authority, ie, people who have actually lived in France, that there are people of all shapes and sizes enjoying hearty portions of rich food and wine.

And as for Japan...there's actually a cultural taboo on being seen to eat large portions of food. Doesn't mean people don't do it at home, though. And the Japanese government's official nutrition recommendations state that adult women should eat meals of 500-700 calories (depending on height/build), plus snacks, totalling around 2000-2500 calories a day. So even with the small portions, it's still recommended to eat far more than the average American woman believes is "healthy".

More Harriet Brown

TAKE THE LOVE YOUR BODY! PLEDGE

About Me

I teach magazine journalism at the S.I. Newhouse School of Public Communications, and write for many magazines and newspapers. My newest book is BRAVE GIRL EATING: A FAMILY'S STRUGGLE WITH ANOREXIA, which will be published by William Morrow this fall. I believe in the power of words to change the world (or at least the interior lives of individuals).